Breast Cancer; The deadliest disease worldwide

Every 15 seconds, somewhere in the world, a woman is diagnosed with breast cancer. Breast cancer is one of the deadliest diseases of the woman worldwide. It contributes 22 percent of all of the newly diagnosed cancer cases in women.

In Asia, Pakistan is the central hub of this disease, and the data in this regard is alarming. According to research, 90000 cases are diagnosed every year, out of which 40000 dies. Women above 50 years are more prone to this disease, but it is also affecting younger women and men too.

Breast cancer is basically the abnormal growth of cells in breast tissues; cells form a tumor that can be felt as a lump or seen on x-ray. Not all the lumps are malignant; some are benign – abnormal growths that do not spread outside of the breast. A benign is not life-threatening until it is pressing on nearby tissues, nerves, or blood vessels causing damage.

A breast is made of lobules that produce milk, ducts that carry milk to the nipples and connective tissues that surround and hold everything together. Breast cancers usually begin in the duct or the glands that produce milk. Sometimes it affects other tissues of the breast, causing sarcomas and lymphomas that are not traditionally considered as breast cancer.

Types of Breast Cancer

There are two common kinds of breast cancers.

• Invasive Ductal carcinoma (IDC), also known as infiltrating ductal carcinoma, is the most common type of breast cancer. It begins in the duct that carries milk from the lobules to the nipples, and as the name indicates, it is “invasive,” which means it spreads to other tissues of the breast. It can also affect lymph nodes and other parts of the body if not treated at an early stage. Almost 80% of breast cancers are invasive ductal carcinoma, which is more likely seen in elderly women of age- 55 or so. It can also affect men.
• Invasive Lobular Carcinoma (ILC) is the second most common type of breast cancer, mainly affecting women of older age. It breaks through the walls of lobules and invades other tissues of the breast and other organs of the body.

About 10% of the breast cancers are invasive lobular carcinoma; it occurs later than the invasive ductal carcinoma- in the early 60s. Hormone replacement therapy is used during and after menopause can increase the risk of ILC.

Inherited Breast Cancer

According to a rough estimate, 5-10% of breast cancers are inherited caused by the passage of mutated genes from parents to offsprings.

Inherited breast cancers are associated with the mutation in the BRCA genes; BRCA1 (BReast CAncer gene one) and BRCA2 (BReast CAncer gene two). The primary function of these genes is to repair cell damage and maintain the normal growth of breast and ovaries. Mutation in one of the two BRCA genes can highly increase the risk of breast cancer. If someone has a strong family history of breast cancer, the doctor will recommend a blood test to identify mutations in the BRCA gene that may be passed to the patient from his parents.

How Breast Cancer Spreads?

Breast cancer mainly spreads in the body through blood vessels or the lymph system.

• The lymph system is composed of lymphatic vessels that connect the lymph nodes throughout the body. Lymph vessels carry the lymph fluid away from the breast; cancer cells can enter this fluid and can travel to lymph nodes through the lymph vessels and can start to grow there. Most of the lymph vessels connect to the lymph nodes, under the arm, around the collar bone, or inside the chest near the Breast bone. Greater the lymph nodes with cancer cells, higher is the chance that it will invade other body organs by traveling through the lymph circulatory system.
• The hematogenous route is the other way of spread through the blood vessels. Blood vessels take the cancer cells from one organ of the body to the other

Breast Cancer stages

Stage Zero                                  

Stage 0 includes all the non-invasive breast cancers such as ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS), but it doesn’t spread to other breast tissues.

Stage One

Stage I refers to all invasive breast cancers. Stage I is divided into subcategories known as IA and IB.

• In stage IA, tumor size measures up to 2cm, but it does not spread outside the breast to the surrounding lymph nodes
• In stage IB, tumor size measures between 0.2-2mm, involving lymph nodes. Stage 0 and I are highly treatable

Stage Two

In stage 2, cancer is invasive but still localized in the breast cells. It is divided into two subcategories

• In stage IIA, either the patient doesn’t have a tumor, but the cancer cells are present in less than four axillary lymph nodes, or tumor size is less than 2 cm, and less than four axillary lymph nodes have cancer cells, or the tumor size is more significant than 2cm but doesn’t involve any lymph nodes.
• In stage IIB, either the patient has a tumor of size 2-5 centimeters and has spread to less than four axillary lymph nodes, or have cancer more massive than 5 cm but doesn’t involve any lymph nodes

Stage II requires strong treatment as compared to earlier stages.

Stage Three

Cancer at this stage is invasive and more advanced. It is further divided into 3 subcategories

• In stage IIIA, either tumor is less than 2 cm, and cancer has spread to 4-9 lymph nodes, or the tumor size is greater than 5 cm, and small clusters of cancer cells are present in the lymph nodes, or cancer may have spread into the lymph nodes, in underarm and breastbone.
• In stage IIIB, the tumor can be of any size. The cancer cell has spread to the breastbone or skin and invaded up to 9 lymph nodes.
• In stage IIIC, either no tumor is present, or tumor is of any size. Cancer cells may have invaded over 10 lymph nodes present near collarbone, breastbone, or underarm. Treatments at this stage include

• Radiation
• Mastectomy
• Hemotherapy
• Chemotherapy

Stage Four

At this stage, breast cancer has invaded other body organs. The organs that are mainly affected include; Brain, Bone, Lungs, and Liver.

Symptoms of Breast Cancer

Symptoms of breast cancer include :

• Swelling of all or part of the breast
• Skin irritation or dimpling
• Breast pain
• Nipple pain or the nipple turning in
• Redness, itching, scaliness, or thickening of the nipple or breast skin
• Nipple discharge other than breast milk-often in red, brown or yellow color
• A lump around the collarbone or in the underarm area
• Enlargement of one breast
• Visible veins on the breast
• Vaginal pain
• Unintentional weight loss

Having one of these symptoms doesn’t vitally mean you have breast cancer, it can also be caused by an infection. You must consult your doctor first for a complete evaluation.

Diagnostic Tests

Early diagnosis can turn the story of breast cancer into a survivor’s tale. Some basic diagnostic tests include

• Physical Examination; The doctor will examine the patient’s breast physically to see any change in breast skin or nipple or if there is any nipple discharge or lump present.
• Medical History; The doctor will ask the patient about his medical history and the medical history of his/her immediate relatives. Because sometimes breast cancers are linked to gene mutations passed through generations of family. The doctor will also ask the patient about his symptoms.
• Mammogram; The doctor may use mammography. A mammogram is an X-ray picture of the breast. It is used for early detection of breast cancer, sometimes up to 3 years before it can be felt.
• Ultrasound; Ultrasonic sound waves are used to produce an image of the internal structure of the breast. The doctor usually goes for an ultrasound if they find any abnormality during the physical examination of the breast or the mammogram.
• MRI; It is the magnetic resonance imaging mainly used for women who have been diagnosed with breast cancer to help measure the size of disease or to look for other tumors in the breast.
• Biopsy; During a breast biopsy, the doctor removes tissue or sometimes fluid from the suspicious area that is later examined in the lab to check for the presence of cancerous cells.

Prevention

As the causes of breast cancer are not entirely known, but the treatments are way better than before, and now we know more ways to prevent the disease, which together can have a significant impact.

Breast Self-Exam

Women should occasionally inspect their breasts and the armpit area to check if there is thickening or hardened knot in the chest, change in nipple size, unusual discharge from the nipple, or a new lump in the breast.

Johns Hopkins Medical center states, “Forty percent of diagnosed breast cancers are detected by women who feel a lump, so establishing a regular breast self-exam is very important.”

Maintain Healthy Weight

Obesity is the root cause of many severe diseases, including cancer. If you are overweight, increase the amount of exercise in your daily life and burn your extra calories. Being overweight can increase the risk of breast cancer, especially after menopause.

Be Physically Active

Adopt a healthy lifestyle- having a lot of physical activities, including exercise. The women who are physically active or do yoga for at least 30 minutes have a lower risk of breast cancer.

Healthy Diet

Mediterranean diet supplemented with extra-virgin olive oil and mixed nuts may have a reduced risk of breast cancer. Try to eat plant-based foods, such as fruit and vegetables, whole grains, legumes, and nuts, and fish instead of red meat.

Don’t smoke and alcohol

Smoking and drinking increase the risk of heart diseases, stroke, and at least 15 cancers, including breast cancer- now that’s enough motivation to stay smoke-free.

Avoid Postmenopausal Hormones

There is a lot of controversy regarding postmenopausal hormones- some women take it after menopause to prevent chronic diseases like osteoporosis or heart diseases; they are considered to lower the rate of a specific condition and may increase the risk of others. Studies show that both estrogen-only hormones and estrogen-plus-progestin hormones increase the risk of breast cancer. So avoid taking postmenopausal hormones for a long time that may have a mixed effect on your health.

Avoid Birth control Pills

Birth control pills have both benefits and risks. It can lower the risk of ovarian cancer, colonial cancer, uterine cancer, and unwanted pregnancy, but it can increase the risk of breast cancer in women. The younger the woman is, the lower the risk is as compared to the woman of older age. 

Breastfeeding for a year or more can lower the risk of breast cancer. It is also very beneficial for the child.

Don’t forget screening

Talk to your doctor when to begin breast screening exams after discussing all the benefits and risks affiliated with it. For most women, regular mammograms can begin at age 40, but specific recommendations vary by age and risk.

• If you are aged 40 – 44: You can choose to begin annual mammograms but after consultation with your doctor about the benefits and risks.
• If you are aged 45 – 54: Mammogram is recommended every year.
• If you are aged 55 or over: Mammogram is recommended every other year.

Find your Family History

Women with a strong family history of cancer have a higher risk of breast cancer. Women having their mother, sister, or any other immediate family member who developed breast or ovarian cancer (especially at an early age) or prostate cancer are at a higher risk and should take proper steps and consult their doctor or genetic counselor. 

There are 3 medicines available for the women at an increased risk of breast cancer, Approved by FDA

• Tamoxifen – for women who either have or have not been through the menopause
• Anastrozole – for women who have been through the menopause
• Raloxifene – for women who have been through the menopause

These medicines can lower the risk, but they do have side effects, so take them only after consultation with the doctor. Some women with a very high risk of breast cancer choose to have their healthy breasts surgically removed (prophylactic mastectomy) to reduce the risk.

Treatments

With advancements in the fields of medicine, cancer treatments are also getting better, and now we have more advanced ways to treat it. Treatment of breast cancer basically depends on

• The type of breast cancer
• The size of the tumor and how far cancer has spread in the body
• If cancer has things called “receptors” for HER2 protein, estrogen, and progesterone, or other specific features.
• Age of patient, menopause history of a patient, and other health conditions are considered while making a decision.

People with breast cancer often get more than one kind of treatment, depending on the stage:

• Surgery where the doctor removes the whole breast, called a mastectomy, or removes just the tumor and tissues around it, called a lumpectomy or breast-conserving surgery.
• Radiation Therapy uses high energy waves to kill cancer cells.
• Chemo Therapy uses drugs to shrink or kill cancer cells. These drugs can be used in the form of pills or medicines injected in the patient’s veins. These drugs are potent in fighting the disease but have side effects too, including hair loss, early menopause, fatigue, nausea, and hot flashes.
• Hormone Therapy uses drugs to block the hormones, mainly estrogen, from assisting the growth of cancer cells. It may also include the use of medications or surgery to stop ovaries from making hormones. Side effects of these drugs include vaginal dryness and hot flashes.
• Targeted Therapy uses drugs to activate the body’s immune system to fight against cancer, and it basically focuses on breast cancer cells that have a high level of a protein called HER2.

 In countries like Pakistan, women’s health has never been a serious topic to discuss. There are a lot of young girls out there who might go undiagnosed from the fear of talking about disease and lose their lives to this disease.

Experts from Shaukat Khanum Memorial Hospital while addressing a seminar said,” The main reason for high growing breast cancer is traditional Pakistani society; there is no system of collecting data and keeping a record of cancer cases.”

Early detection of breast cancer is the key to survival. Now, it is the responsibility of all to spread awareness individually, promote awareness for the regular examination, screening, and donate to cancer societies, hospitals, and people who need funds for treatment. We all have to join hands in this battle against cancer.

Do have a regular check-up and also encourage others that might save one’s life.